Decision Making under the Mental Capacity Act The Mental Capacity Assessment and Best Interests Decision-making Tool

Transcription

1 Decision Making under the Mental Capacity Act The Mental Capacity Assessment and Best Interests Decision-making Tool Joanne Brown Professional Support and Practice Development Nurse (LD)

2 The CIPOLD review of deaths.. Has also identified considerable concerns about adherence to the MCA... A key concern has been lack of assessment to establish that a person might not have the capacity to make a particular decision in some cases capacity appeared to be made on the basis of their appearance included delays in convening Best Interest meetings Who should take the lead in Best Interest decision-making Poor recording of best interest decisions Misunderstandings about the process to follow in case of disagreement.

3 Health Professionals use Section 5, Best Interests all the time, especially in Emergency departments, just don t realise it! BUT when they have time to consider investigations for people without capacity some struggle with Best Interest process

4 Issues when not using the MCA Capacity assessments not completed Referred to psychology / psychiatrists for capacity assessment -?relevant information for assessment If person says no that decision is accepted even if the person lacks capacity Presumption not tolerate investigation / treatment / aftercare

5 Reasons given on GP records for not accessing cervical screening Out of 303 people only 107 had a cervical smear (35%) Disclaimer Refused Non-responder Parents refused No information Not indicated as sexually active Reference to MCA and patients best interests (2 cases)

6 Diagnostic investigations GP referrals directly for investigations At appointment often cannot be carried out as the person lacks mental capacity to consent, person has to go back to GP Causes delays in diagnosis and treatment

7 Conclusions People with learning disabilities do not access cancer screening and diagnostic investigations the same as the general population. Main reason is because of lack of mental capacity and lack of understanding of the implications of not having tests / treatment carried out. Health professionals have a lack of knowledge how to support people with learning disabilities

8 Best Interest Meetings Complex decisions / people with complex needs need a Best Interest meeting BUT Take time to organise confusion of who organises Has an impact on medical professionals time

9 Solution? Often at appointments the right people are in attendance:- Patient Decision maker Person/s who knows the patient best No reason why capacity cannot be assessed at the appointment Only complicated decisions need a best interest meeting with multi professionals in attendance

10 MCA & BI Form for Health Investigations / Treatment Aims to:- Make life easier & give suggestions to assist Record rationale for decision-making Be clear and transparent Can be used at Best Interest meetings BUT. It takes time to complete it This would be considered a reasonable adjustment

11 MCA & BI Form for Health Investigations / Treatment Step 1 Involve people who know the person best Step 2 Refer to IMCA service if no family member to consult Step 3 Assume the person has mental capacity to make the decision Step 4 Carry out Mental Capacity Assessment Step 5 Carry out a Best Interest discussion Step 6 Document your reasons every step of the way. This will help you to reach a final decision Step 7 Record agreement with everyone present. Everyone signs form

12 Is it used? Shared with local hospital Included in guidance documentation for learning disabilities Shared with GP Practices GP s / Practice Nurses don t like writing A template is put on GP systems Capacity and Best Interests decisions will be recorded on patients records

13 REMEMBER He who fails to plan, plans to fail Proverb